纵向弛豫时间定量成像联合钆延迟增强对扩张型心肌病患者的诊断价值  

T1 mapping and late gadolinium enhancement for the diagnosis of dilated cardiomyopathy

作　　者：崔倩[1] 于静[1] 葛夕洪[1] 高光峰[1] 刘洋[1] 沈文[1] Cui Qian;Yu Jing;Ge Xihong;Gao Guangfeng;Liu Yang;Shen Wen(Department of Radiology,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院放射科,天津300192

出　　处：《中华危重病急救医学》2020年第12期1506-1510,共5页Chinese Critical Care Medicine

基　　金：天津市卫生健康委员会科技人才培育项目(RC20184)。

摘　　要：目的探讨T1 mapping联合钆延迟强化(LGE)对扩张型心肌病(DCM)的诊断价值。方法选择2018年4月至2019年11月因不明原因急性心力衰竭(心衰)而经超声检查考虑为DCM的32例患者为研究对象;同时纳入同一时间段检查心脏磁共振成像(CMRI)的18例体检者为对照组。采用飞利浦Ingenia 3.0T检查所有受检者心脏,平扫检查项目包括T2加权成像(T2WI)、电影序列、增强前的native T1 mapping;增强检查项目包括延迟增强及增强后post T1 mapping、首过灌注。使用钆喷酸葡胺注射液作为对比剂,首过灌注剂量为0.1 mL/kg,以相同速度追加生理盐水20 mL,延迟7 min开始进行延迟增强序列扫描,包括4层2腔心位和4腔心位。观察LGE联合T1 mapping的CMRI结果,包括心功能指数〔左室舒张期末容积(LVEDV)、左室收缩期末容积(LVESV)、左室射血分数(LVEF)、瓣膜反流〕、心脏形态学指标〔左心室质量(LVM)〕、组织学特点(T2图像心肌信号、有无灌注缺损及其位置和范围、有无延迟增强及其位置、形态和范围、增强前后T1值)、细胞外容积(ECV)及伴随征象(心包积液、胸腔积液)等指标;绘制受试者工作特征曲线(ROC),评价增强前T1 mapping的T1值对DCM的诊断价值;同时观察临床终点事件发生情况。结果DCM组患者性别、年龄、体重指数(BMI)、血压、心率(HR)、血细胞比容(HCT)、肌酐(Cr)、高血压和心脏病家族史患者比例比较差异均无统计学意义。DCM组患者N末端脑钠肽前体(NT-proBNP)水平和心功能Ⅲ级、糖尿病、吸烟史、饮酒史、用药史患者比例明显高于对照组(均P<0.05)。与对照组比较,DCM组LVEDV(mL/m^(2):234.9±35.9比121.8±27.6)、LVESV(mL/m^(2):189.7±42.8比54.8±17.0)、LVM(g:197.6±56.3比110.5±22.9)、增强前T1值(ms:1332.1±35.9比1272.0±41.0)、ECV〔(45.7±4.9)%比(28.0±2.1)%〕水平均明显升高;LVEF(0.191±0.107比0.554±0.103)、增强后T1值(ms:453.9±72.7比493.5±43.9)均明显降低Objective To explore the role of T1 mapping and late gadolinium enhancement(LGE)for detection of dilated cardiomyopathy(DCM).Methods Thirty-two DCM patients detected by ultrasonic testing with unknown origin heart failure from April 2018 to November 2019 were involved.In addition,they were compared with 18 physical examiner under cardiac magnetic resonance imaging(CMRI)in the same period.Phillip's Ingenia 3.0T MRI was used to examine heart function,plain scan included cine,T2 weighted imaging(T2WI)and pre-contrast native T1 mapping.The enhancement scan included perfusion weighted imaging,LGE imaging and post-contrast post T1 mapping.Using gadolinium injection,a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered.After a 7-minute later start scanning,delay enhance sequence was started,including 4 layers,2 cavities and 4 cavities.LGE and T1 mapping results were observed,including cardiac function indexes[left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),valvular regurgitation],cardiac morphological indexes[left ventricular mass(LVM)],histological characteristics(T2WI myocardial signal,presence of perfusion defect and its position and scope,presence of delayed enhancement and its position,shape and scope,pre-and post-contrast T1 values),extracellular volume(ECV)and the accompanying signs(pericardial effusion and pleural effusion).The receiver-operating characteristic curve(ROC)was drawn,the diagnostic value of T1 value of pre-contrast T1 mapping for DCM was evaluated,and the occurrence of clinical endpoint events was observed.Results There were no statistically significant differences in DCM patients with gender,age,body mass index(BMI),blood pressure,heart rate(HR),hematocrit(HCT),creatinine(Cr),family history of hypertension or heart disease.In DCM group N-terminal brain natriuretic peptide precursor(NT-proBNP)level and proportion of patients with heart function levelⅢ,diabetes,smoking hi

关 键 词：钆延迟强化 纵向弛豫时间定量成像 扩张型心肌病 心力衰竭 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]